| NPI | 1962604223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 6825) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 41357) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2022-07-21 |